The Infection Control Risks Associated with the Use of Mobile Technology in Healthcare

Abstract

Mobile technology i.e. virtual reality (VR) headsets are rapidly gaining popularity in healthcare, offering a wide range of applications from distraction therapy for improving patient wellbeing to educational training for medical professionals. Despite this, there has been no prior research to assess their impact on infection control or to authenticate recommendations on how health care workers (HCWs) should ensure their safe usage. Using a range of culture dependent and independent methods, in addition to external 16S sequencing, horizontal gene transfer (HGT) investigation and trialling Loop Mediated Isothermal Amplification (LAMP) for specific and rapid diagnostics, this thesis aimed to answer an essential question: Does VR have the potential to pose infection control risks to the immunocompromised individuals that they are intended to help? It aimed to determine the full extent of these risks, how they compare against those from other forms of mobile technology used in hospitals and to conclude the most effective means to mitigate them. A range of commensal but opportunistic bacteria were isolated from the VR clinical trials samples including Micrococcus luteus, Rothia terrae, Corynebacterium freneyi and Bacillus although the majority were Staphylococci, many exhibiting antibiotic resistance. The culture independent analysis revealed a far greater species diversity than initially indicated, with Bacillus species being particularly abundant. The viability of several frequently found potential pathogens and other species of clinical significance were tested on VR, phones and tablets to determine which were most likely to be survive on their surfaces and be transmissible between individuals sharing a single device. It found that Pseudomonas aeruginosa, Escherichia coli, Staphylococcus epidermidis and Mycobacterium smegmatis persisted up to 60 minutes on VR, phones and tablets but only Staphylococcus aureus, Staphylococcus saprophyticus and Bacillus cereus remained after 24 hours and only S. saprophyticus and B. cereus after 7 days. When tested further, B. cereus was shown to remain viable at least 14 days and even to sporulate on the plastic surfaces of a VR headset. Of the several sanitation interventions trialled, alcohol wipes (Wilkinsons) were found to be the most reliable, practical and effective mode of cleaning. It was determined that several factors could influence the amount of contamination collected on VR headsets, with older devices, those without waterproof coatings and those using soft material or porous plastic masks being found to harbour the greatest amount. VR headsets were shown to be capable of facilitating HGT via transformation between competent E. coli cells, even under sub optimal conditions, although the transformation rate was very low. LAMP primers designed to target B. cereus’ dltA gene were proven to be highly specific and sensitive (32 cells per reaction) allowing for the rapid detection of the specific pathogen on device surfaces. Overall, the results of this thesis suggest that whilst VR headsets like other forms of frequently used mobile technology do have the potential to serve as infection control risks, the possible threats they pose can be fully mitigated by selecting suitable device models for clinical use i.e. the Pico G2 which have minimal material surfaces and by implementing routinely used, effective sanitation interventions to minimise contaminant accumulation.

Date of Award	2023
Original language	English
Supervisor	Emma Hayhurst (Supervisor) & Jeroen Nieuwland (Supervisor)